For women in St. Joseph, Missouri, the YWCA is a critical support. 

The organization provides emergency shelter for women leaving domestic violence situations, plus transitional housing and access to licensed therapists and case managers. 

And in February, in partnership with the Stuber Health Center and Heart to Heart International, the YWCA was able to provide another important service: breast and cervical cancer screenings. 

It is a new collaborative effort between Stuber and Heart to Heart to use mobile clinics to increase the rate of women in Buchanan County obtaining the important health checks. The organizations plan to take their mobile clinics across the county on the final Friday of every month to screen as many women as possible for cervical and breast cancer. 

Marilyn Gantz is staying at the YWCA as she waits to get into an apartment, hopefully this month. It’s been five years since she got a pap smear or a mammogram. 

“It means a lot,” Gantz said about the mobile clinic setting up for the day across from the women’s shelter. “There was plenty of notice. Getting signed up was quick and easy.” 

Making it easy to get the screenings was a priority for the staff at Stuber Health Center. The center sent paperwork over days in advance, so women could adjust their schedules, pre-register and fill out the forms at their own pace. 

The clinic had five sign-ups for its first outing. The plan is to continue providing these services throughout St. Joseph and, eventually, to branch out to more rural areas of the county. 

Success for the program will in part rely on collaborations in the community.

Latha Varghese recently became Stuber Health Center’s executive director after working part-time there as a nurse practitioner for several years. She’s reaching out to community organizations like the food bank and the Salvation Army to coordinate future events and to get in touch with Missourians who may struggle to find access to health screenings. 

“We are also looking to reach out to the homeless population,” Varghese said. “Down the road, we are hoping to go north of us in the more rural areas. We are just trying to make collaborations at this point.” 

How Stuber Health Center works in the community

Although the community is aware that what they pay at the clinic is based on their income, Stuber ran into a hiccup when doing outreach in the community: Women weren’t coming into the clinic for their screenings. 

“That’s why we started this mobile unit,” Varghese said. “So we can go out and reach people where they are.” 

Issues like transportation and getting time off work can keep women from getting screenings at the recommended rate, said Danyelle Kerns, a nurse practitioner who has worked at Stuber for five years.  

“I think it’s nice to be able to bring the clinic to the patient, to get out into the field,” Kerns said.

“We want to get into rural areas, because I think that’s where health care lacks the most,” Kerns said. “Obviously a lot of women can’t get into town to get their services done.” 

State data confirm what Kerns has seen while working at the center. 

In 2022, 33.7% of rural women ages 40 to 75 reported not having a mammogram in the past two years, compared to 30.4% of urban women. Current recommendations suggest women over 50 receive annual mammograms. 

Data from a 2015 breast cancer study found that women living in non-metropolitan counties were slightly more likely to have late-stage breast cancer than women in metropolitan areas, at 32% versus 30.7%. 

Stuber Health Center is a quasi-governmental provider of health care services across Buchanan County. About 60% of the center’s funding comes from city, county, state or federal dollars, including the federal Title X program. The clinic also partners with Missouri’s ShowMe Healthy Women (SMHW) program, which aims to reduce cancer rates among Missouri women. 

To qualify for coverage for certain screenings under the program, patients must have a household income at or below 250% of the federal poverty level. 

“ShowMe Healthy Women is like a last resort,” Varghese said. “If the patients don’t have any insurance, then (the program) pays for it.” 

Although the clinic aims to provide nearly 300 screenings under the ShowMe Healthy Women program annually, fewer women have been using the program since Missourians voted to pass Medicaid expansion under the Affordable Care Act in 2020. In 2024, the center provided almost 200 screenings under the SMHW program. 

“In the last few years, with the ACA program, a lot of patients got onto Medicaid, as well as marketplace insurance,” Varghese said. “That number started to drop because there’s fewer people that are without insurance.” 

Data show that 53% of women who used ShowMe Healthy Women to obtain a cancer screening were ages 50 to 64, while 33.7% were ages 40 to 49 and 12.7% were younger than 40.

How Missouri is hoping to reduce breast and cervical cancer rates 

Missouri set goals through its cancer action plan for 2021 to 2025, which aims to reduce cancer rates and increase cancer screenings. 

Missouri ranks 29th for its per capita rate of breast cancer incidences, at 133 cases per 100,000 residents from 2017-2021. For cervical cancer, the state ranks 28th, with 8.3 cervical cancer diagnoses per 100,000 people. 

Based on 2020 data, 69.4% of Missouri women 40 and older had a mammogram within the past two years. By this year, the state is aiming to raise that rate to 79%. Like many forms of cancer, early diagnosis of breast cancer significantly reduces the risk of dying.  

For cervical cancer screenings, 78.2% of Missouri women ages 21 to 65 had a pap smear within the last three years. The state’s target to reach by this year is 93%. The five-year survival rate for cervical cancer is lower than for breast cancer, and 90% of cervical cancer cases are caused by the human papillomavirus (HPV).

Title X clinics like Stuber Health Center are critical for low-income women who rely on them for cancer screenings. During President Donald Trump’s first term, he implemented a policy called the “domestic gag rule” that prevented Title X funds from flowing to organizations that referred patients to abortions. 

As a result, Planned Parenthood and seven states dropped out of the Title X program, and the number of cervical cancer screenings provided fell sharply. 

As Trump acts quickly to cut spending in Washington, Title X providers fear what it could mean for their services. 

“I try not to get political, but I am worried about our funding in general,” Kerns said. “We rely on a lot of federal funding to keep us going. If that’s getting cut, it does worry you.” 

Regardless, Kerns said she thinks collaborations like these are important when trying to connect more people with health care services. 

“A lot of women have difficulty making it into a clinic, and they put off getting their screens done,” she said. “Cervical and breast cancer are some of those ones that, if caught early, can be lifesaving.”